Personal narrative intervention for older children with Down syndrome

Language disorder is common in children with Down syndrome (DS). Yet, research on language intervention for older children with Down syndrome is lacking, leaving little guidance for the practicing SLP. This feasibility study provides us with some guidance, aimed at improving the personal narratives of older children with DS. Four children with DS participated, aged 10–15, all with MLUs greater than 3.0, intelligibility > 70%, and no other neurological disorders.

Intervention schedule:

  • 18 treatment sessions, 3 times per week for 30–60 minutes per session
  • Sessions divided into six-week blocks, each with specific objectives:
    • First six weeks: noun phrase elaboration and who
    • Middle six weeks: advanced verb phrases and what
    • Last six weeks: conjunctions, where, and when

Intervention characteristics:

A primary feature of the intervention was heavy use of visual supports. The children were trained and encouraged to create their own visual supports that could later be used to tell personal narratives. Between intervention sessions, the children took pictures with an app on an iPod Touch, to document important or interesting activities in their lives. Narrative maps, created by the clinician, were also used during intervention (simply a paper or whiteboard diagram, with blocks to remind students what to include, e.g. “when, where, who, what, talking [as in “What did people say?”], and feelings”). These visual supports were found to be crucial, adding to “…evidence that suggests individuals with DS have strengths in visual processing that can be leveraged to improve relative weaknesses in narrative language (Chapman et al., 1998; Roberts et al., 2008).”

Session activities:

  • The clinician modeled a personal narrative
    • “The purpose of the models was to demonstrate well-structured, cohesive personal narratives to participants.”
    • Narratives included at least 5 examples of targeted objective (above), and the clinician provided explicit instruction on where grammatical and narrative targets occurred
  • The child retold the adult’s modeled personal narrative
    • With pictures, narrative maps, and clinician instruction/support
  • The child told their own personal narrative
    • With pictures, narrative maps, and clinician instruction/support
    • Clinician reminded student to “…include dialogue, mental state, and the targeted narrative and grammatical goals when telling their personal narrative…”
  • The child participated in a sentence imitation task
    • “…the interventionists prompted participants to imitate 12 sentences, each containing an example of the session’s target grammatical and narrative goals… loosely related to the session’s model personal narrative…”

So, did it “work”? First, recall that this is a study of only four students—so outcomes aren’t yet generalizable. Nonetheless, the researchers examined many language outcomes, including: MLU-M (mean length of utterance in morphemes), percent of on-topic narrative utterances, and several others. They found that, “each participant demonstrated intervention growth on at least one of the dependent variables.” Also, “…participants readily took pictures between sessions and parents reported that they believed these photos helped to support their child’s sharing of a personal event.”

Finestack, L., O’Brien, K.H., Hyppa-Martin, J., & Lyrek, K.A. (2017). The evaluation of a personal narrative language intervention for school-aged children with Down syndrome. American Journal on Intellectual and Developmental Disabilities, 122(4), 310–322.